• Severe, diffuse abdominal pain
• Gross or occult intestinal bleeding
• Minimal physical findings
• Radiographic findings of vascular occlusion
• Operative findings of ischemic bowel
• Predominantly a disease of the elderly
• Tissue injury is caused by both ischemia itself as well as reperfusion
• Mesenteric arterial emboli (50%): Commonly originate from mural thrombus in an infarcted LV or clot in a fibrillating LA
• Thrombosis of a mesenteric artery (25%): The end result of atherosclerotic stenosis; often a history of intestinal angina
• Rare causes of acute arterial occlusion include:
• Thrombosis of mesenteric veins (5%): Associated with portal hypertension, abdominal sepsis, hypercoagulable states, or trauma
• Nonocclusive mesenteric ischemia accounts for the remaining 20% of cases of mesenteric ischemia
• Serum amylase is elevated
• Significant base deficits
• Increased serum phosphate
• Increased serum lactate
• Antithrombin III deficiency and other abnormalities of coagulation should be sought in cases of venous thrombosis
• Abdominal x-ray:
• Specific findings occur late
• GI contrast radiography: Thumbprinting and disordered motility
• CT scan
-Diffuse distention with air-fluid levels
-Intestinal wall thickening
-Gas in the portal venous system
• Mesenteric arteriography: The gold standard showing disrupted intestinal arterial blood flow or absence of a venous phase
• Survival depends on diagnosis and operative treatment within 12 hours after onset of symptoms
• In the early stages, there is a striking paucity of abdominal findings
• Pain out of proportion to the objective findings is a hallmark of mesenteric vascular occlusion
• Later in the disease course, abdominal distention and tenderness occur
• Shock and generalized peritonitis eventually develop
• Causes of hypercoagulability should be sought postoperatively in cases of venous thrombosis
• Resection of all involved gut; revascularization of proximal stenosis indicated to salvage viable bowel; thrombectomy usually unsuccessful
• Role of angioplasty and stenting combined with operation depends upon the precise vascular lesions
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